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海绵窦段颈内动脉与垂体大腺瘤解剖关系的定量分析

Quantitative analysis of anatomical relationship between cavernous segment internal carotid artery and pituitary macroadenoma.

作者信息

Lin Bon-Jour, Chung Tzu-Tsao, Lin Meng-Chi, Lin Chin, Hueng Dueng-Yuan, Chen Yuan-Hao, Hsia Chung-Ching, Ju Da-Tong, Ma Hsin-I, Liu Ming-Ying, Tang Chi-Tun

机构信息

Department of Neurological Surgery, Tri-Service General Hospital Department of Surgery, Tri-Service General Hospital Songshan Branch Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C.

出版信息

Medicine (Baltimore). 2016 Oct;95(41):e5027. doi: 10.1097/MD.0000000000005027.

DOI:10.1097/MD.0000000000005027
PMID:27741111
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5072938/
Abstract

Cavernous segment internal carotid artery (CSICA) injury during endoscopic transsphenoidal surgery for pituitary tumor is rare but fatal. The aim of this study is to investigate anatomical relationship between pituitary macroadenoma and corresponding CSICA using quantitative means with a sense to improve safety of surgery.In this retrospective study, a total of 98 patients with nonfunctioning pituitary macroadenomas undergoing endoscopic transsphenoidal surgeries were enrolled from 2005 to 2014. Intercarotid distances between bilateral CSICAs were measured in the 4 coronal levels, namely optic strut, convexity of carotid prominence, median sella turcica, and dorsum sellae. Parasellar extension was graded and recorded by Knosp-Steiner classification.Our findings indicated a linear relationship between size of pituitary macroadenoma and intercarotid distance over CSICA. The correlation was absent in pituitary macroadenoma with Knosp-Steiner grade 4 parasellar extension.Bigger pituitary macroadenoma makes more lateral deviation of CSICA. While facing larger tumor, sufficient bony graft is indicated for increasing surgical field, working area and operative safety.

摘要

垂体瘤经鼻内镜经蝶窦手术中海绵窦段颈内动脉（CSICA）损伤虽罕见但可致命。本研究旨在采用定量方法研究垂体大腺瘤与相应CSICA之间的解剖关系，以提高手术安全性。在这项回顾性研究中，2005年至2014年间共纳入98例行内镜经蝶窦手术的无功能垂体大腺瘤患者。在4个冠状层面测量双侧CSICA之间的颈动脉间距，即视柱、颈动脉隆凸凸面、蝶鞍中部和鞍背。采用Knosp-Steiner分类法对鞍旁扩展进行分级并记录。我们的研究结果表明，垂体大腺瘤大小与CSICA上的颈动脉间距之间呈线性关系。Knosp-Steiner 4级鞍旁扩展的垂体大腺瘤不存在这种相关性。更大的垂体大腺瘤会使CSICA向外侧偏移更多。面对较大肿瘤时，需要足够的骨移植以增加手术视野、操作空间和手术安全性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7cc/5072938/52e1f5904864/medi-95-e5027-g007.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7cc/5072938/52e1f5904864/medi-95-e5027-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7cc/5072938/b83a4b8e395c/medi-95-e5027-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7cc/5072938/af4957b19178/medi-95-e5027-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7cc/5072938/2e9808b16b2f/medi-95-e5027-g005.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7cc/5072938/52e1f5904864/medi-95-e5027-g007.jpg

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